How accurate are the home sleep studies and are they really necessary?

DUG wrote: ↑

Wed Aug 22, 2018 1:36 pm

I don't have any graphs from the titration at all. I only have a summary that the sleep testing center sent to my GP.

You should demand the full report from the lab. I did with my sleep lab and found discrepancies between the study data and the written report and I made them re-write the report.

I don't know about demanding things. I told them that I will destroy them, their children, and everyone they hold dear, while screaming into the phone and cursing them.

They weren't impressed, more annoyed than anything. The tech is going to request them from the ether, hopefully get approved by the nefarious force that approves such things, and then send them to me in an email, eventually.

Ok, they sent them. All that demanding for nothing. I kind of feel bad now.

They want to set my machine 5min-8max. ?

What am I looking for exactly, or do you want me to post 5 pages of stuff?

DUG wrote: ↑

Wed Aug 22, 2018 2:08 pm

What am I looking for exactly, or do you want me to post 5 pages of stuff?

I'm not suggesting you are looking for anything specific, but rather that you should have them for your reccords. My sleep doctor went out of business, so having copies of my reports turned out to be handy.

If you post the full PSG you may get some additional input from some of the more experienced folks here. I'm not a sleep technologist nor a respiratory therapist, so I don't have a lot of insight into these things. I'd redact the patient name and info and the doctor and sleep lab names and info before posting.

DUG wrote: ↑

Wed Aug 22, 2018 9:25 am

I haven't tried the EPR setting. I read online that EPR doesn't really do much, for most users.

I'm a bit over a month on xPAP and I've had EPR turned off with starting pressures of 11 or lower. For lack of a better description, my breaths did not feel "satisfying" with it on. However, I've been increasing my minimum pressure. I started at 5 about four weeks ago and have been working my way up to 12, since the machine seems to auto adjust me to around 13 for the majority of the night. At a starting pressure of 12, I have found that it now feels hard to exhale without EPR turned on. So for the past couple of nights, I have had EPR at 3 and that feels "right". So for me, EPR wasn't needed until I reached a higher starting pressure. Your experience may likely be different. Or similar. Who knows?

I have found it is all a bit of an education and you will do yourself a solid favor listening to the wealth of experience & knowledge on the forum. I have and it is appreciated!

Good luck!
-JD

DUG wrote: ↑

Wed Aug 22, 2018 2:08 pm

looking for exactly,

If possible, full written summary (but with identifiers removed), hypnogram, and pressure charts showing results and durations of pressures tried.

DUG wrote: ↑

Wed Aug 22, 2018 2:08 pm

I told them that I will destroy them, their children, and everyone they hold dear, while screaming into the phone and cursing them.

Sleep first, apologize later. But I'm no lawyer.

DUG wrote: ↑

Wed Aug 22, 2018 1:36 pm

online they are $16, unheated, just the basic hose.

They're under 7 on Amazon and ebay.

DUG wrote: ↑

Wed Aug 22, 2018 1:40 pm

It takes WAY more than that to get banned here...

But for the record, the main thing is having that titration for your personal files. It is possible there is useful background/side info in the titration that will help the likes of Pugsy and PR, but the SleepyHead charts posted from using the starting pressure they recommend will likely be more useful than anything in that lab titration, I'm guessing.

I wouldn't necessarily automatically compensate for the drop during exhale when using EPR if it were me until I saw proof of the need.
Sometimes we do need to increase the minimum pressure because of using EPR but we don't always have to do that.
I would wait and see before I did it...if it were me.

I use a minimum of 7 with EPR at 3 and my pressure will often hit 16 and my AHI is almost always below 1.0 and when it's not it's most usually SWJ stuff and not real stuff getting flagged.

Your choice and you can of course try both ways but going to 7 or 8 with adding in EPR is going to be a whole lot more easier of an adjustment than going to 11 with EPR at 3. You may or may not even need much more minimum when adding in the EPR drop during exhale. It's easy to spot if you do though.

Oh..as far as titration studies coming up with the "optimum settings"....don't take it to the bank and count on it.
Any number of things can cause them to come up with less than optimal settings and the range of 5 to 8....hogwash IMHO.
I had a titration study and they didn't get it right for me either.

JayDee wrote: ↑

Wed Aug 22, 2018 2:52 pm

DUG wrote: ↑

Wed Aug 22, 2018 9:25 am

I haven't tried the EPR setting. I read online that EPR doesn't really do much, for most users.

For lack of a better description, my breaths did not feel "satisfying" with it on.

I know exactly what you mean. And it gets worse if I get a little panicky. It feels like if my lungs or chest were just an inch bigger, my brain would feel like I got a proper full deep breath. There has to be a word for that. It's the feeling that I got enough air on that inhale and can exhale now. Sometimes, I have to sit up or lean back and take my biggest inhale to feel like I got that "satisfying" amount. If I don't get it, I feel like I need to keep trying until I do.

Pugsy wrote: ↑

Wed Aug 22, 2018 3:07 pm

IOh..as far as titration studies coming up with the "optimum settings"....don't take it to the bank and count on it.
Any number of things can cause them to come up with less than optimal settings and the range of 5 to 8....hogwash IMHO.
I had a titration study and they didn't get it right for me either.

I'm a little baffled by the idea of setting prescriptions based on a single one night titration study given the rather high variability in AHI from night to night.

Titrations are mostly just for proving to payers that breathing improved with application of pressure. Titrations can reveal limb issues and problems adapting to straight pressure. They can also get someone in the ballpark for a place to start. But no single-night titration has ever truly optimized PAP settings, IMO.

Stom wrote: ↑

Wed Aug 22, 2018 3:22 pm

I'm a little baffled by the idea of setting prescriptions based on a single one night titration study given the rather high variability in AHI from night to night.

Well I suppose in a perfect world we can all go to a foreign place...sleep in a strange bed...all wired up with a new contraption on our faces and sleep just like we do at home (never mind we don't even sleep the same at home every night)...I guess they sometimes get it right or get it close.
I didn't sleep well at all and that was with RX sleep aids and I only got 6 minutes of REM sleep over the entire night which totaled up to barely 186 minutes of sleep over the allowed 8 hour period. Plus I had the dufus sleep tech from hell trying to force me to wear a mask that I couldn't wear because it was killing my neck. Finally had to threaten him to just up and leave if he didn't at least let me try the one I wanted to try (which by the way worked just fine after arguing with him half the night about it).
I swear to this day if I saw him in the crosswalk I would be tempted to run him down.

The lack of REM was a critical issue for me because that's when my OSA is worse and when my pressure needs vary a lot. Never got to really test out any pressures in REM. Big waste of my time and money and by the end of the night I was ready to kill someone I felt so bad. Massive headache and my blood pressure was at stroke level when I left. They won't ever have a chance to do that to me again.

Quite honestly....I am surprised that they sometimes actually do it right but then even a blind hog finds an acorn every now and then.
They got close...for me anyway..close for non REM sleep pressure needs. No where near what I need in REM though.
Fortunately I had already bought my own machine privately and got an apap and with the help of the folks here and the software at the time I got the pressure settings dialed in rather quickly once I had the software. Back then we had to buy it and it took some time to get here and we needed special card readers which we also had to buy...so took a bit of time to get all the ducks in a row and see the reports and then do something about them.

For plain jane vanilla OSA...doing a home titration with an apap machine will do a good enough job and probably easier in the long run and a whole lot less costly.
Now for the people who need one of those high end specialty machines for special reasons....titration studies when done properly are probably the best way to go and even then sometimes need a little tweaking.

Pugsy wrote: ↑

Wed Aug 22, 2018 3:41 pm

I swear to this day if I saw him in the crosswalk I would be tempted to run him down.

Public service, that would be.

Pugsy wrote: ↑

Wed Aug 22, 2018 3:41 pm

Now for the people who need one of those high end specialty machines for special reasons....titration studies when done properly are probably the best way to go and even then sometimes need a little tweaking.

Resmed asv machines are so good at bringing order from chaos, I'd say those don't need a titration... now, for copd or other lung diseases, yeah, stuff needing a VAPS, yeah...

zonker wrote: ↑

Wed Aug 22, 2018 11:04 am

DUG wrote: ↑

Wed Aug 22, 2018 9:51 am

It seems to me that Apnea is a lot like alcoholism in that if you think you have it, you probably do, or you would never have thought about it.

not for me. i wasn't even thinking of sleep apnea. was complaining to my gp about waking up so often during the night to pee and how i never really ever got any sleep.

he recommended me to a sleep doctor. and off i went from there.

Not for me either. I wanted to stop snoring. Did not believe I had OSA. I simply wanted to get my wife and I sleeping in the same bed again. I had no idea how bad off I was until I started feeling better after using the machine for awhile.